Chronic kidney disease is a widespread health issue in the United States, affecting approximately 37 million adults and increasing the risk of kidney failure, cardiovascular disease, and mortality. Early detection and treatment of chronic kidney disease during young adulthood could reduce its progression and prevent kidney failure and cardiovascular disease.
However, few studies have examined chronic kidney disease risk factors during young adulthood. The Kidney Disease Improving Global Outcomes (KDIGO) staging system, which combines eGFR and UACR, can identify chronic kidney disease and its progression better than standard cardiology guidelines. Nontraditional factors related to cardiovascular health, such as FVC, inflammation, serum urate, and serum carotenoids, may also play a role in kidney function.
New research published in The American Journal of Medicine has revealed that nontraditional risk factors are associated with chronic kidney disease (CKD) progression in young adults, with similar magnitudes across the three category transitions. The study identified that FVC, serum urate, serum carotenoids, GlycA, and hsCRP were strongly linked to CKD progression. These factors remained significant even after accounting for conventional factors known from studies of older adults or high-risk groups.
The study also demonstrated that inflammation, oxidative stress, and endothelial dysfunction biomarkers were positively associated with future hypertension, insulin resistance, and diabetes, which can lead to further decline of kidney function. Inflammatory processes are already in place and may influence CKD progression early in life. GlycA, a novel marker of systemic inflammation, as being in the pathway for CKD progression.
The study revealed that serum carotenoids are inversely associated with progression to more advanced CKD categories. These carotenoids derive from plant foods and are highly correlated with healthy behavior. The study also found that high serum urate is at least a marker of CKD progression, indicating a potential pathophysiologic contribution of reduced lung function to the development of CKD.
Emphasis was laid on the significance of monitoring kidney function in individuals with reduced lung function. The findings are generally consistent with prior information about conventional factors advancing CKD. Despite extensive knowledge about the importance of dyslipidemia control in patients with CKD, whether triglycerides and HDL-C have a role in CKD progression in the general population has yet to be well elucidated. However, the study found that individuals with high triglycerides and low HDL-C had a greater risk for CKD progression.
The strengths of this study include joint evaluation of nontraditional and conventional factors for progression through the modified KDIGO stages. The study has a prospective design with a high retention rate among survivors and repeated clinical measurements that enable us to explore dynamic changes in factors and progression through CKD categories.
The present study’s findings provide valuable insights into the predictive factors of chronic kidney disease progression in younger adults. Identifying nontraditional markers of lung function, inflammation, serum urate, and serum carotenoids as predictors of CKD progression highlights the importance of assessing multiple risk factors when evaluating kidney health.
The high incidence of transition to a higher CKD category despite the relatively young age of the cohort emphasizes the need for increased awareness and monitoring of kidney function in young adults. Routine assessment of the urinary albumin-to-creatinine ratio can be valuable for identifying individuals at risk for hypertension, diabetes, and cardiovascular disease.
The results of this study also call for further research to better understand the development and progression of CKD in young adults, which can ultimately inform preventive strategies and early interventions to mitigate the burden of CKD in this population.
